Provider Demographics
NPI:1194380147
Name:COLMED CLINIC LTD
Entity Type:Organization
Organization Name:COLMED CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-770-6300
Mailing Address - Street 1:3615 N ASHLAND AVE APT 1N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4742
Mailing Address - Country:US
Mailing Address - Phone:773-770-6300
Mailing Address - Fax:773-665-5007
Practice Address - Street 1:3615 N ASHLAND AVE APT 1N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4742
Practice Address - Country:US
Practice Address - Phone:773-770-6300
Practice Address - Fax:773-665-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center